Paraplegia caused by a thoracic angiolipoma obscured by cord injury: a case report

Spinal epidural angiolipomas are rare benign tumors comprising 0.5-1% of all spinal neoplasms and typically arise in the thoracic spine, causing progressive myelopathy due to spinal cord compression. They feature mature adipocytes and vascular proliferation, show heterogeneous magnetic resonance imaging (MRI) enhancement, and may mimic posttraumatic or degenerative myelopathy, particularly in patients with prior spinal cord injury.

A 56-year-old man presented with a 3-month history of progressive numbness and weakness in both lower limbs. He had sustained a cervical spinal cord injury 5 years earlier and remained ambulatory with a walker after cervical laminoplasty. At initial evaluation, neurological examination demonstrated symmetric lower-extremity weakness, a sensory level below T12, hyperreflexia in both legs, and preserved bladder and bowel function. Cervical MRI showed chronic postoperative change at C5-6 without a new compressive lesion, and the symptoms were initially attributed to sequelae of the prior cervical injury. During 1 month of observation, the patient developed worsening paraparesis and progressive sensory deficit. Whole-spine MRI then revealed a posterior epidural mass at T11-12 causing marked cord compression and extending into the right neural foramen. The lesion showed high signal intensity on T1- and T2-weighted images with heterogeneous contrast enhancement, favoring a vascularized fat-containing tumor. The patient underwent T11-12 laminectomy and gross total resection. Histopathological examination confirmed epidural angiolipoma composed of mature adipocytes and proliferating vascular channels. Postoperatively, neurological symptoms improved without complication, and the patient remained improved at 1-month follow-up.

Spinal epidural angiolipoma should be considered in patients with prior spinal cord injury who present with new-onset myelopathy. Whole-spine MRI screening is critical for preventing diagnostic delays and facilitating favorable surgical outcomes.